Mood Disorders Practice Questions

Q: A 32-year-old woman is diagnosed with major depression. What is the chance that her identical twin sister will develop the same disease?

70%. ### Explanation **1. Understanding the Correct Answer (D: 70%)** The question tests the concept of **concordance rates** in psychiatric genetics. Concordance refers to the probability that if one twin has a disorder, the other will also develop it. For Major Depressive Disorder (MDD), studies on Monozygotic (identical) twins—who share 100% of their genetic material—show a concordance rate of approximately **50% to 70%**. This high percentage highlights a significant genetic predisposition, although environmental factors also play a role. **2. Analysis of Incorrect Options** * **Option A (5%):** This is closer to the lifetime prevalence of MDD in the general population (approx. 5-12% for men). * **Option B (20%):** This represents the concordance rate for **Dizygotic (fraternal) twins**, who share only 50% of their genes. It is also the approximate risk for a first-degree relative of a patient with MDD. * **Option C (50%):** While some older studies cite 50%, modern psychiatric literature and NEET-PG patterns frequently use the upper limit (70%) to emphasize the high genetic load in identical twins compared to fraternal twins. **3. NEET-PG Clinical Pearls & High-Yield Facts** * **Bipolar Disorder (BPAD):** Has an even higher genetic link than MDD. Monozygotic twin concordance is **70-90%**, while Dizygotic is **15-25%**. * **Schizophrenia:** Monozygotic twin concordance is approximately **40-50%**. * **General Rule:** If a question asks for twin concordance in major psychiatric illnesses, BPAD > MDD > Schizophrenia. * **First-degree relatives:** The risk for MDD in a first-degree relative of an affected individual is roughly **2 to 3 times** higher than the general population.

Q: "Learned helplessness" is typically seen in which of the following conditions?

Depression. **Explanation:** **Correct Answer: D. Depression** The concept of **Learned Helplessness** was proposed by **Martin Seligman** based on animal models (the "shuttle box" experiment with dogs). It describes a state where an individual, after facing repeated uncontrollable stressors, stops attempting to escape or change the situation, even when an opportunity for relief becomes available. In clinical psychiatry, this serves as a cognitive model for **Depression**. It explains the core symptoms of hopelessness, passivity, and a lack of motivation. Patients perceive that they have no control over their environment, leading to the belief that "nothing I do matters," which reinforces the depressive cycle. **Why other options are incorrect:** * **Delirium (A):** This is an acute organic brain syndrome characterized by fluctuating consciousness and impaired attention, not a learned cognitive behavior. * **Dementia (B):** This involves a chronic, global impairment of cognitive functions (memory, executive function). While patients may become passive, it is due to neurodegeneration rather than a learned psychological response. * **Schizophrenia (C):** While "avolition" (lack of motivation) is a negative symptom of schizophrenia, it is linked to dopamine dysregulation in the reward pathways rather than the cognitive framework of learned helplessness. **High-Yield Clinical Pearls for NEET-PG:** * **Attributional Style:** In depression, individuals attribute negative events to **Internal, Stable, and Global** causes (e.g., "It’s my fault, it will always be this way, and it affects everything"). * **Biochemical link:** Learned helplessness is associated with decreased levels of **Norepinephrine** and **Serotonin** in the brain. * **Treatment:** Cognitive Behavioral Therapy (CBT) aims to reverse learned helplessness by challenging these maladaptive thought patterns.

Q: According to DSM-IV criteria, what is the minimum duration of depressed mood or loss of interest or pleasure required for the diagnosis of a Major Depressive Episode?

2 weeks. **Explanation:** The diagnosis of a **Major Depressive Episode (MDE)** according to DSM-IV (and DSM-5) requires a specific cluster of symptoms to be present for a minimum duration to distinguish clinical depression from transient sadness or "the blues." 1. **Why Option B is Correct:** The diagnostic criteria mandate that at least **five** out of nine symptoms (including either depressed mood or anhedonia) must be present nearly every day for at least **2 consecutive weeks**. This 14-day threshold is the standard clinical benchmark used to ensure the symptoms represent a persistent change from previous functioning. 2. **Why Other Options are Incorrect:** * **Option A (1 week):** This is the duration required for a **Manic Episode**. A single week is considered too short for a definitive diagnosis of MDD. * **Option C (3 weeks):** This duration has no specific diagnostic significance in the classification of mood disorders. * **Option D (4 weeks):** While symptoms often last longer than a month, waiting four weeks would delay necessary clinical intervention. (Note: 4 weeks is the duration required for Post-Traumatic Stress Disorder symptoms). **High-Yield Clinical Pearls for NEET-PG:** * **The "SIGECAPS" Mnemonic:** Sleep, Interest (Anhedonia), Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation. * **Dysthymia (Persistent Depressive Disorder):** Requires a depressed mood for at least **2 years** (1 year in children/adolescents). * **Cyclothymia:** Requires at least **2 years** of hypomanic and depressive periods that do not meet full criteria. * **Post-Stroke Depression:** Most commonly associated with lesions in the **Left frontal cortex**.

Q: Which of the following conditions is ECT most useful in?

Acute Depression. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Acute Depression** (specifically Major Depressive Disorder with melancholic or psychotic features) is the condition where ECT shows the highest efficacy and most rapid response. **Why Acute Depression is Correct:** ECT is considered the "gold standard" for treatment-resistant depression or when a rapid clinical response is required (e.g., severe suicidal ideation, refusal to eat, or catatonia). It works by inducing a generalized seizure, which leads to a massive release of neurotransmitters and increases BDNF (Brain-Derived Neurotrophic Factor) levels. **Analysis of Incorrect Options:** * **A. Mania (Acute):** While ECT is effective for acute mania (especially delirious mania), it is typically reserved as a second or third-line treatment after mood stabilizers (Lithium, Valproate) and antipsychotics. * **B. Chronic Schizophrenia:** ECT is generally not effective for the negative symptoms of chronic schizophrenia. It is primarily used in schizophrenia for acute exacerbations, catatonic features, or when there is a strong affective (mood) component. * **C. Panic Disorder:** ECT has no established role in the treatment of anxiety disorders like Panic Disorder. These are managed with SSRIs and Cognitive Behavioral Therapy (CBT). **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are **no absolute contraindications** for ECT, but increased intracranial pressure (ICP) is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia (memory loss) and post-ictal confusion. * **Mortality Rate:** Approximately 0.01 per 1,000 patients (similar to general anesthesia). * **Electrode Placement:** Bilateral (Gold standard for efficacy) vs. Unilateral (Fewer cognitive side effects).

Q: Mania is characterized by?

Loss of insight. **Explanation:** In Psychiatry, **insight** refers to a patient’s ability to understand that they have a mental illness, recognize its symptoms, and accept the need for treatment. In **Mania**, the loss of insight is a hallmark feature. Patients typically experience a state of "ego-syntonic" euphoria, believing they are functioning at their peak. This lack of awareness is why manic patients often refuse medication and require involuntary hospitalization. While high self-esteem is a symptom, the **loss of insight** is the defining clinical characteristic that complicates management. **Analysis of Options:** * **A. Paranoid Delusion:** While delusions can occur in "Mania with Psychotic Features," they are more characteristic of Schizophrenia. In mania, delusions are typically **grandiose** (inflated power/knowledge) rather than paranoid. * **B. Loss of Orientation:** Orientation (to time, place, and person) remains **intact** in mood disorders. Disorientation suggests an organic brain syndrome or Delirium. * **C. High Self-esteem:** This is a common symptom (Grandiosity), but it is not as definitive or clinically significant as the loss of insight. A person can have high self-esteem without being manic, but a manic patient almost universally lacks insight into their pathological state. **NEET-PG High-Yield Pearls:** * **DIGFAST** Mnemonic for Mania: **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressured speech). * **Insight Scale:** Often measured using the G12 item of the PANSS or the Birchwood Insight Scale. * **Key Distinction:** Hypomania is distinguished from Mania by the *absence* of psychotic features and the fact that it does *not* cause marked impairment in social or occupational functioning.

Q: ECT is mainly indicated in:

Severe depression. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Severe Depression** (especially Major Depressive Disorder with psychotic features or suicidal ideation) is the primary and most common indication. **Why Severe Depression is Correct:** ECT is considered the "gold standard" for rapid symptom relief in severe depression. It is specifically indicated when: * There is a high risk of suicide (requires immediate intervention). * The patient is stuporous or refusing food/fluids (nutritional compromise). * The depression is resistant to multiple trials of antidepressants. * Psychotic features are present. **Analysis of Incorrect Options:** * **Schizophrenia:** While ECT is used in schizophrenia (specifically catatonic type or acute exacerbations resistant to antipsychotics), it is a second-line treatment. Antipsychotics remain the primary treatment. * **Somatization Disorder:** This is a chronic condition characterized by multiple physical complaints. Treatment focuses on psychotherapy (CBT) and conservative management; ECT has no role here. * **Hysteria (Dissociative/Conversion Disorder):** These are neurotic, stress-related disorders. The mainstay of treatment is psychotherapy and addressing underlying stressors. ECT is not indicated. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves) and post-ictal confusion. * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Mechanism:** It works by inducing a generalized tonic-clonic seizure (minimum duration: 25-30 seconds). * **Modified ECT:** Involves the use of an anesthetic (Thiopentone/Propofol) and a muscle relaxant (Succinylcholine) to prevent fractures.

Q: Which of the following symptoms must be present for the diagnosis of manic-depressive psychosis?

Loss of interest or pleasure. **Explanation:** The term **Manic-Depressive Psychosis (MDP)**, historically used by Emil Kraepelin, is now synonymous with **Bipolar Disorder**. To diagnose a depressive episode within this spectrum (according to ICD-10/ICD-11 and DSM-5 criteria), certain **core (typical) symptoms** must be present. **Why Option A is Correct:** **Loss of interest or pleasure (Anhedonia)** is one of the two "gateway" symptoms of a Major Depressive Episode. According to diagnostic criteria, at least one of the following must be present: 1. Depressed mood. 2. **Loss of interest or pleasure (Anhedonia).** Without at least one of these core symptoms, a diagnosis of depression cannot be made, regardless of how many other somatic symptoms are present. **Why Other Options are Incorrect:** * **B, C, and D (Suicidal ideation, Indecisiveness, and Insomnia):** These are considered **accessory or secondary symptoms**. While they are common and included in the diagnostic criteria (e.g., SIGECAPS), they are not mandatory for the diagnosis if other criteria are met. A patient can be diagnosed with depression without having suicidal thoughts or insomnia, but they cannot be diagnosed without depressed mood or anhedonia. **High-Yield Clinical Pearls for NEET-PG:** * **Core Triad of Depressive Episode (ICD-10):** Low mood, Anhedonia, and Low energy (Easy fatigability). * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode plus one Major Depressive episode. * **Lithium** remains the gold standard for maintenance treatment in MDP/Bipolar Disorder. * **Nihilistic delusions (Cotard Syndrome)** are most commonly associated with severe psychotic depression.

Q: Which of the following medicines is associated with the side effect of sexual dysfunction?

Fluoxetine. **Explanation:** **Fluoxetine** is a Selective Serotonin Reuptake Inhibitor (SSRI). Sexual dysfunction is one of the most common and distressing side effects of SSRIs, occurring in approximately 30% to 60% of patients. The underlying mechanism involves the stimulation of **5-HT2 receptors** in the spinal cord and brain, which inhibits the spinal reflexes associated with orgasm and ejaculation, and decreases dopamine release in the reward centers, leading to reduced libido. **Analysis of Incorrect Options:** * **Mianserin:** This is a tetracyclic antidepressant (TeCA) that acts as an antagonist at H1, α1, α2, and 5-HT2 receptors. Because it blocks 5-HT2 receptors rather than increasing serotonin at those sites, it is generally associated with a much lower risk of sexual dysfunction compared to SSRIs. * **Bupropion:** This is a Norepinephrine-Dopamine Reuptake Inhibitor (NDRI). It does not affect the serotonergic system. In fact, it is often used as an "add-on" or alternative treatment to alleviate SSRI-induced sexual dysfunction because it enhances dopaminergic neurotransmission. **Clinical Pearls for NEET-PG:** * **Most common sexual side effects:** Delayed ejaculation and anorgasmia. * **Management:** If sexual dysfunction occurs, the clinician may consider a "drug holiday" (briefly stopping the drug over the weekend), switching to **Bupropion, Mirtazapine, or Nefazodone**, or adding **Sildenafil**. * **High-Yield Fact:** Among SSRIs, **Paroxetine** is often cited as having the highest incidence of sexual side effects.

Question 1

A 32-year-old woman is diagnosed with major depression. What is the chance that her identical twin sister will develop the same disease?

Accepted Answer

70%

Answer

5%

Answer

20%

Answer

50%

Question 2

"Learned helplessness" is typically seen in which of the following conditions?

Accepted Answer

Depression

Answer

Delirium

Answer

Dementia

Answer

Schizophrenia

Question 3

According to DSM-IV criteria, what is the minimum duration of depressed mood or loss of interest or pleasure required for the diagnosis of a Major Depressive Episode?

Accepted Answer

2 weeks

Answer

1 week

Answer

3 weeks

Answer

4 weeks

Question 4

Which of the following conditions is ECT most useful in?

Accepted Answer

Acute Depression

Answer

Mania (Acute)

Answer

Chronic Schizophrenia

Answer

Panic Disorder

Question 5

Mania is characterized by?

Accepted Answer

Loss of insight

Answer

Paranoid delusion

Answer

Loss of orientation

Answer

High self-esteem

Question 6

ECT is mainly indicated in:

Accepted Answer

Severe depression

Answer

Schizophrenia

Answer

Somatization disorder

Answer

Hysteria

Question 7

Which of the following symptoms must be present for the diagnosis of manic-depressive psychosis?

Accepted Answer

Loss of interest or pleasure

Answer

Recurrent suicidal ideation

Answer

Indecisiveness

Answer

Insomnia

Question 8

Which of the following is a risk factor for suicide?

Accepted Answer

Initial stages of recovery from depression

Answer

Being on Lithium treatment

Answer

Being married

Answer

Being employed

Question 9

Which of the following medicines is associated with the side effect of sexual dysfunction?

Accepted Answer

Fluoxetine

Answer

Mianserin

Answer

Bupropion

Answer

None of the above

Question 10

A 34-year-old housewife reports a three-month history of feeling low, lack of interest in activities, lethargy, multiple body aches, feelings of worthlessness, decreased appetite, and disturbed sleep with early morning awakening. She is likely to benefit from:

Accepted Answer

Anti-depressants

Answer

Anti-psychotics

Answer

Anxiolytics

Answer

Hypno-sedatives

Mood Disorders — MCQs

Mood Disorders — MCQs

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